Spill - Template

Top Of Iowa Co-op - 311431242

101 North Park Lake Mills, IA

Winnebago County

FO 2

Site Name:

Address:

City:

County:

State:

Zip:

Directions:

Section:

Tier:

Range:

Long:

Lat:

Spill Number:

111009-KAL-1329

Spill Location:

43.420000, -93.540000

Spill County:

Winnebago

FO 2

Incident Report

Received:

Received By:

Discovered:

Assigned To:

Reported By:

Anonymous

DNR Observation

Individual

Company:

Name:

Title:

Phone:

Email:

Incident Information:

Sec:
Tier:
Range: W
Lat:
Long:

Responsible Party

Remove Facility

Is Individual

Unknown

Company:

Phone:

Email:

Address:

City:

State:

Zip:

Spill Contact

Name:

Title:

Phone:

Email:

Address:

City:

State:

Zip:

Select	Name	Program	Type

Material Information


Material: Medium: Quantity: Units:

Transportation:

Fish Kill:

Continuous Release:

Date of Investigation:

Incident Investigated:

Status:

Compliance Determination:

30 Day Report Not Expected

Transferred To Contaminated Sites:

Report

Attached Files/Reports

File Name	File Type	File Date	Note

Comments

Date	Comment	Commenter
11/10/2009	The pipe was removed and a pinhole leak was discovered. The contaminated soil will be excavated and probably be sent to a landfill since it contains rock and gravel. The pipe will be reset and tested before the line is put back in service.	KATHY LEE

Comment:

Public Water Suppliers

Name	Supply Type	PWS ID	Operator: Name / Phone Number	Contacted

Compliance Tracking

Action Type	Date	Completed Date	Comment	Delete

Multiple Results Found

Field Office Compliance - Spill

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Top Of Iowa Co-op - 311431242

101 North Park Lake Mills, IA

Winnebago County

FO 2

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Public Water Supply: Surface Water